Scheer Inka, Thakar Ranee, Sultan Abdul H
Urogynaecology, Mayday University Hospital, 530 London Road, Croydon CR7 7YE, UK.
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Sep;20(9):1095-101. doi: 10.1007/s00192-009-0908-8. Epub 2009 May 28.
To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS).
A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section.
Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS.
Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL.
前瞻性评估既往发生产科肛门括约肌损伤（OASIS）后再次分娩后的肛肠症状、生活质量（QoL）、括约肌完整性及功能。
在孕晚期及产后13周进行经过验证的曼彻斯特健康问卷、肛门内超声检查及测压。对于肛门功能无客观受损的女性，建议经阴道分娩，其他女性则建议剖宫产。
73名既往有OASIS的连续女性在随后的妊娠期间接受观察，其中59名在产后13周接受复查。再次经阴道分娩或剖宫产后，肛门测压结果无显著变化。经阴道分娩后仅出现1例新的缺陷（内括约肌）。症状或生活质量无显著变化。3例（6.8%）再次发生OASIS。
产前无肛门括约肌功能客观受损证据的女性可放心，经阴道分娩不会导致功能或生活质量出现任何显著恶化。
